Cough stress tests to diagnose stress urinary incontinence in women with pelvic organ prolapse with indication for surgical treatment

Abstract

Aims: To evaluate the diagnostic ability of different cough stress tests (CSTs) in women with pelvic organ prolapse (POP), performed during outpatient urogynaecological exams.Methods: Prospective, multicentre observational study involving women on waiting lists for POP surgery. With a subjectively full bladder, patients were asked to perform five different CSTs: without prolapse reduction ([a] standing, followed by [b] semilithotomy position); keeping semilithotomy position with prolapse reduced (by [c] posterior speculum, followed by [d] pessary); [e] standing again with the pessary in place. Primary outcome was positive CST in at least one of the five CSTs. Bladder volume was measured and symptoms of stress urinary incontinence (SUI) were detected by two validated questionnaires. Results: A total of 297 women completed all CSTs and were included in the analyses. Mean (SD) age, parity, and body mass index were 64.8 (9.9) years, 2.7 (1.3) deliveries, and 26.6 (3.4) kg/m 2 , respectively. In total, 99 women (33.3%) reported SUI symptoms. At least one positive CST was recorded in 152 patients (51.1%), and in 90 (59.2%) of these 152, a positive CST was observed only when POP was reduced (occult SUI). The CST was positive in 92 (92.9%) of the 99 patients with coexisting SUI symptoms and in 60 (30.3%) of the 205 asymptomatic patients. The percentage of patients with a positive CST was significantly lower when bladder volume was <200 mL vs ≥200 mL (P = .046). Conclusions:The identification of urinary leakage cases with CSTs is best achieved using multiple different patient positions, different prolapse reduction methods, and bladder volumes ≥200 mL. K E Y W O R D Scough stress test, pelvic organ prolapse, stress urinary incontinence ---

International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction

“…Eighty-nine percent of the women with a positive stress test were diagnosed when performing at least two of the three tests with prolapse reduction, and 98% were diagnosed when performing all three tests with prolapse reduction (speculum and pessary reduction in the semi-lithotomy position, pessary reduction in the standing position). The authors also emphasized the importance of adequate bladder volume (200 ml) [ 63 ]. The findings were not compared with postoperative outcomes.…”

Flexible and Stretchable Piezoresistive Sensor with Decoupled Pressure Sensing Capability

“…The result shows consistent resistance values regardless of the internal pressure or bladder size, which implies that the sensor is not affected by the natural bladder motion (Figure 3b). When an external pressure of the order of 5–15 kPa is applied to the bladder with a finger poke motion that mimics the abnormal pressure caused by coughing or laughing, [ 48 ] the sensor produces a distinctly noticeable response that corresponds to the decoupled response toward the pressure without interference from the bladder's natural movement (Figure 3c). The device in aquatic conditions further demonstrates viable operation after implantation on the bladder surface (Figure S11, Supporting Information).…”

Perfil ginecológico e obstétrico, perda de urina e qualidade de vida de idosas com incontinência urinária

“…Juliato et al (24) , ao verificarem a prevalência de IU em mulheres, demonstraram que tanto a colporrafia anterior, a posterior e a histerectomia prévia foram fatores associados à IU. Espuña-Pons et al (25) ao aplicaram o teste de estresse para tossepara verificar se há perda de urina ao tossirem mulheres que aguardavam a cirurgia de prolapso de órgãos pélvicos, verificaram que de 297 mulheres, 51% apresentaram teste positivo.…”